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ppt for nurses chapter 9 perioperative care.pptx

The document outlines the phases of perioperative care, including preoperative, intraoperative, and postoperative stages involved in surgical treatment. It discusses various types of surgery (elective, emergency, major, minor) and emphasizes the importance of patient preparation, consent, and risk assessment prior to surgery, as well as procedures and equipment needed throughout each stage of care. Additionally, it addresses intraoperative and postoperative procedures aimed at preventing complications and facilitating recovery.

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01/04/2025 By SENTAYEHU PERI-OPERATIVE CARE 1 CHAPTER 9
01/04/2025 By SENTAYEHU 2 Surgery  is a means of treating injury and disease.  It encompasses three phases preoperative, Intraoperative and postoperative.  All three phases are referred to a Perioperative nursing. Surgery may be performed  for diagnostic (e.g. excision of a tumor or inflamed appendix) or reparative (e.g. multiple wound repair). It may be reconstructive or cosmetic (e.g. mammoplasty or face lift) or  palliative (e.g. to relieve pain or correct a problem for instance a gastrostomy tube may be inserted to compensate for the inability to swallow food).
01/04/2025 By SENTAYEHU 3 Degree of urgency It can be classified as elective or emergency. 1. Elective surgery: may be planned weeks to months ahead and based on the client’s choice.  It is performed to satisfy the desire of the client but not needed to preserve the client’s life, body part or body function. E.g. cosmetic surgery, 2. Emergency surgery: is performed to preserve the client’s life, body part or body function. E.g. to control internal hemorrhage
01/04/2025 By SENTAYEHU Cont’d… 4 Degree of risk:  It can be classified as major surgery or minor according to the degree of risk to the client. 1. Major surgery: it involves a high degree of risk for a variety of reason.  It may be complicated or prolonged large loss of blood may occur vital sign may be involved. E.g. organ transplant, open heart surgery 2. Minor surgery: It involves little risk produces few complications. E.g. breast biopsy
01/04/2025 By SENTAYEHU 5 PERI-OPERATIVE CARE • is a period of time that constitutes the surgical experience including:  preoperative,  intra-operative and  post operative phases. 01/04/2025 5 By DelelegnT.
Pre-operative care 01/04/2025 By SENTAYEHU 6  is a care given for a patient from the time the decision is made for surgical intervention to the transfer of the patient to the operating room Purpose  To prepare the patient emotionally, mentally for surgery  To prevent complication before surgery unless it is an emergency operation  To promote patient and family involvement in care
Informed Consent 01/04/2025 By SENTAYEHU 7  Prior to any surgical procedures, client must sign a surgical consent form. This requirement protects clients from having any surgical procedures that do not want or do not know about. It is the part of a physician legal responsibility which involves providing the client until all the information needed to make the decision undergo surgery. Informed consent is necessary in the following circumstances. Invasive procedure such as a surgical incision a biopsy a cystoscopy or Paracentesis. Procedures requiring sedation or anesthesia. A non surgical procedure
General checkup 01/04/2025 By SENTAYEHU 8 Assessing general risks The degree of risk involved in surgical procedure is affected by the clients  Age many young and elderly clients are greater surgical risk than children and adults.  Nutritional status: two nutritional problems that can increase surgical risks are obesity and malnutrition due to protein, iron, and vitamin deficiencies. o Obese patient have overtaxed hearts and elevated blood pressure and incision in overly fatty tissues are difficulties to suture and prone to infection. o Protein and vitamins are needed for wound healing vitamin K is essential for blood clotting.
… 01/04/2025 By SENTAYEHU 9  Fluid and electrolyte status  Medication: - the regular use of certain medication can increase surgical risk.  E.g. anticoagulant increase blood coagulation time, Tranquilizers may cause hypotension and thus contribute to shock  Health problem: such as angina pectoris, sever hypertension, myocardial infarction etc.  Blood coagulation disorder: that may lead to sever bleeding, hemorrhage.  Upper respiratory tract infection: they may predispose the client to postoperative lung infection.  Uncontrolled neurological disease such as epilepsy  Diabetes mellitus: which predispose the client to wound infection and delayed healing.  Screening test: The physician orders preoperative radio logic and laboratory tests and examination.
01/04/2025 By SENTAYEHU 10 Equipment: 1. Blood pressure apparatus 2. Stethoscope 3. Enema equipments and solution as needed 4. Catheterization equipments a. Flashlight b. Preoperative checklist c. Container for dentures, glasses
Cont’d… 01/04/2025 By SENTAYEHU 11 d. Appropriate storage for valuables and clothes e. Information packets regarding surgery f. Informed consent forms g. Intravenous fluids, IV set, syringe and needles, and equipment as needed h. Preoperative medication i. Transfer cart
Procedures of pre-operative care 01/04/2025 By SENTAYEHU 12 1. Explain the procedure 2. Check whether the client has any questions regarding the surgery and understands the procedure. 3. Wash hands 4. Verify admission orders regarding type of surgery, any risks (including recent changes in vital signs), and client preparation 5. Verify the client by checking name tag and asking name 6. Make the patient NPO for six to eight hours 7. Complete the preoperative checklist, including history, physical assessment, and check of valuables.
Cont’d… 01/04/2025 By SENTAYEHU 13 8. Perform neurological assessment, including checks for orientation, eye coordination, handgrips, knee bends, and plantar and dorsi-flexion of the feet 9. Perform vascular assessment including checks of pulse, blood pressure, and apical pulse rhythm, peripheral pulses, and temperature. Compare with previous information.  Clients over 50 years may require baseline electrocardiogram
Cont’d… 01/04/2025 By SENTAYEHU 14 10. Auscultate the lungs bilaterally front and back. If any wheezes, rhonchi, coughs, upper respiratory infections, or increased temperature, notify physician or qualified practitioner 11. Assess the gastrointestinal system (time of last meal, food allergies, bowel sounds, last bowel movement, time of last fluids). 12. Assess the genital/urinary system (last menstrual period, last void, state of pregnancy, estrogen replacement therapy).
… 01/04/2025 By SENTAYEHU 15 13. Assess skin and muscle tone for any skin breakdown, redness, bruises, decreased skin integrity 14. Ascertain any allergies or adverse reactions during previous surgeries or use of anesthesia. 15. Obtain medication history, including the time and date of the last dose of medication 16. Ascertain any history of drugs/alcohol use and when they were last used. 17. Check weight.
Cont… 01/04/2025 By SENTAYEHU 16 18. Check if family is available and who is present 19. Ascertain if client has signed the surgical consent. 20. Remove all valuables with the exception of wedding rings if requested. Tape rings in place. Check and document whether valuables are placed in a locked area, safe storage area, or given to family. 21. Check if eyeglasses and dentures are removed; place in a labeled container
Cont’d… 01/04/2025 By SENTAYEHU 17 22. Maintain elimination as needed (catheterization, enema) 23. Administer intravenous fluids according to orders 24. Administer medications according to orders. 25. Ascertain that preoperative checklist is complete. 26. Transport the client to appropriate area. 27. Inform family members where surgical waiting area is and establish a way to contact them when surgery is completed
Preoperative teaching 01/04/2025 By SENTAYEHU 18  It includes teaching moving, leg exercise, deep breathing exercise and coughing Purpose Moving:  To maintain blood circulation  To stimulate respiratory function  To decrease stasis of gas in the intestine  To facilitate ambulation Leg exercise: To stimulate blood circulation there by preventing thrombopheleblitis and thrombus formation
01/04/2025 By SENTAYEHU 19
… 01/04/2025 By SENTAYEHU 20  Deep breathing and coughing  To facilitate lung aeration thereby preventing atelectasis and pneumonia.  To promote blood circulation to and from the lungs there by preventing pulmonary embolism Procedure a) assist the client to fowler’s position(sitting) b) Have a client place hands palms down with middle finger touching along lower border of rib cage. c) Ask client to inhale slowly through the nose feeling middle fingers separate hold breath for 2to3 seconds. d) Have client exhale slowly through mouth repeat three to five times.
01/04/2025 By SENTAYEHU 21
Intra-operative care 01/04/2025 By SENTAYEHU 22 Definition:  Intra-operative care is a care given for a patient from when the patient is transferred to operation room table to when the patient is admitted to the recovery room or post anesthesia care unit.
01/04/2025 By SENTAYEHU 23 Purpose of Intra-operative care • To prevent risk of infection • To reduce risk of injury related to Positioning chemical hazards foreign objects left in the body
… 01/04/2025 By SENTAYEHU 24 There are a lot of activities it includes:  Assessing the client’s physiologic and psycho logic status.  Reviewing the results of the diagnostic tests and lab studies.  Positioning the client for surgery performing the surgical preparation.  Assisting in preparing the sterile field.  Monitoring and maintain a safe, aseptic environment.  Managing catheters, tubes, drains and specimen.  Performing sponge sharp and instrument count.  Administering medication and solution to the sterile field.
… 01/04/2025 By SENTAYEHU 25  Nurses assist surgeon in the operating room. The two basic categories of assistant are the sterile assistant and the circulating assistant.  The sterile assistant (scrub nurse) is scrubbed. Gowned and gloved he/she functions within the sterile field.  Duties include handling instruments to the surgeon, threading needles, cutting sutures assisting with retraction and suction and handling specimen.  The circulating nurse works outside the sterile field.  Duties include opening sterile packs delivering supplies and instruments to the sterile team delivering medication to sterile nurse labeling specimens and keeping records during the surgical procedure.
01/04/2025 By SENTAYEHU 26 Equipment  Gloves (clean for shaving; sterile for cleaning surgical site)  Razor and sharp blades  Sterile gauze (to clean the razor)  Warm water  Antibacterial cleansing agent  Sterile cotton swabs  Sterile cotton sponges  Transfer forceps in antiseptic solution  Solution for surgical site cleaning, such as 70% alcohol Solution basins
01/04/2025 By SENTAYEHU 27 Procedures 1. Review chart for surgery to be performed and determine the exact area to be prepared. 2. Wash hands. 3. Assess client’s level of consciousness and mobility 4. Explain the procedure to client. 5. Be sure that hairpins, jewelry, nail polish, contact lenses, prostheses, and dentures were re-moved during the preoperative preparation. 6. Assist client with transfer from wheelchair or bed to the surgical table. 7. Position the client for optimal access to the surgical site according to institutional protocol 8 .Cover with blanket
Cont’d… 01/04/2025 By SENTAYEHU 28 9. Cover hair if required 10. Assemble equipment needed 11. Remove ring(s) and watch. Wash hands and apply clean gloves. 12. The surgical prep sites follow, depending on the type of surgery to be performed.  Head and neck: The site extends from above the eyebrows and includes the ears and both anterior and posterior areas of the neck. The face and eyebrows are not shaved.
Cont… 01/04/2025 By SENTAYEHU 29  Lateral neck: Clean the external auditory canal with a cotton swab.  Anteriorly, prepare the side of the face, from above the ear to the upper thorax to just below the clavicle.  Posteriorly, prepare from the neck to the spine including the area above the scapula.  Chest surgery: The site extends from the neck to the bottom of the rib cage and to the lateral midline. The shoulder and arm of the operative side should be included.  Abdominal surgery: The preparation site extends from the axilla to the pubis extending bilaterally to the lateral midline. All visible pubic hair should be shaved.
01/04/2025 By SENTAYEHU 30  Perineal surgery: Shave all pubic hair and the inner thighs to the midthigh.  The area starts above the pubic bone anteriorly and extends beyond the anus posteriorly. Cervical spine surgery: Posteriorly from the top of the ears to the waist.  The area extends on each side to the midaxillary line. Lumbar spine surgery :Posteriorly from the axilla down to the midgluteal level of the buttocks. The area extends on each side to the midaxillary line
01/04/2025 By SENTAYEHU 31  Rectal surgery: Shave the buttocks from the iliac crest down to the upper third of the thighs, including the anal region. The area extends to the midline on each side.  Flank surgery: Extends anteriorly from the axilla, down to the upper thigh, including the external genital area.  Posteriorly the area extends from the midscapular to the midgluteal regions
01/04/2025 By SENTAYEHU 32  Hand and forearm surgery: The area includes the full circumference of the affected arm, from the axilla to the fingertips. Lower extremity surgery: The area includes the entire leg, toes, and foot of the affected leg from the umbilicus anteriorly and the top of the buttocks posteriorly. Lower leg surgery: The area to be prepared includes the circumference of the entire region from midthigh to the distal toes of the affected leg.
Cont…procedure 01/04/2025 By SENTAYEHU 33 13. Arrange for adequate light on the area to be prepared. 14. Using warm water, hold the skin taut and hold the razor at a 45° angle. Shave the area carefully by stroking in the direction of hair growth. Rinse the razor carefully to remove accumulated hair from the blade. 15. Dry the client’s skin with a sterile towel.
Cont’d… 01/04/2025 By SENTAYEHU 34 16. Clear the shaving supplies from the preparation area. 17. Apply sterile gloves and gown. 18. Scrub the surgical site with an antibacterial cleaner. Using a rotary movement to clean the skin, begin in the center and gradually enlarge the area with each rotation.
….cont 01/04/2025 By SENTAYEHU 35 19. Continue this process for three to ten minutes as prescribed by institutional policy. 20. Clean any hidden areas in the surgical site (the ear canals, under the fingernails, the umbilicus) using cotton swabs. 21. Rinse the area with sterile water. Wait for the site to dry or pat dry with a sterile towel. 22. Cover the area with sterile drapes leaving the surgical site exposed  C:UserstoshibaDesktop Hand_washing,scrubing_gowning_gloving Surgical Hand Scrub Learning Module.mp4  C:UserstoshibaDesktop Hand_washing,scrubing_gowning_gloving Gloving,Gowning,and Surgical Scrub.mp4
Postoperative Care 01/04/2025 By SENTAYEHU 36 Definition:  Postoperative care is a care given for a patient which begins with the admission of the patient to the post anesthesia care unit and ends after follow up evaluation in the clinical setting. Purpose  To prevent any complication from anesthesia  To detect sign of post operative complications  To rehabilitate the patient  To re-establish physiological equilibrium  To alleviate pain
01/04/2025 By SENTAYEHU 37 Equipments 1. Vital sign equipments  Stethoscope  Sphygmomanometer  Thermometer 2. Watch, Anesthetic bed 3. Oximeter 4. Blankets 5. Cardiac monitoring equipment 6. Sterile dressings as needed 7. Client’s chart with postoperative orders 8. Incentive spirometer (may be optional) 9. Supplemental oxygen, if needed 10. Sequential stockings and/or antiembolic stockings (as ordered) 11. Gloves
01/04/2025 By SENTAYEHU 38 Procedures 1. Wash hands and apply gloves. 2. Check the client’s temperature, pulse, respiratory rate, and blood pressure upon the client’s arrival in the unit. 3. Identify client via armband and verify the client’s identity with the chart. 4. Inform the client that she/he is out of the operating room and in the recovery room.
Cont’d… 01/04/2025 By SENTAYEHU 39 5. If bedside electrocardiogram monitoring is available, attach the leads to the client and run a baseline electrocardiogram strip. 6. Attach the oximeter to the client and monitor the client’s oxygen saturation
01/04/2025 By SENTAYEHU Cont… 40 7. Check intravenous (IV) site using gloves. Check IV solution(s), flow rate, and that the IV line is taped as necessary 8. Check surgical dressing and site, if visible. Assess dressings for amount and type of drainage. Reinforce the dressings as needed. 9. Complete a total head to toe assessment
… 01/04/2025 By SENTAYEHU 41 10. Encourage the client to deep breathe, cough, and use the incentive spirometer 11. Check and implement postoperative orders. 12. Inform the client’s family or significant other that the client is in the recovery room.
01/04/2025 By SENTAYEHU 42 13. Turn the client every hour, maintaining proper alignment. 14. Upon discharge by the postanesthesia care-giver, a full report of the postanesthesia phase and intraoperative course of events should be given to the nurse assuming care of the client. 15. Remove gloves and wash hands.
General instructions 01/04/2025 By SENTAYEHU 43 • If patient shows any sign of shock immediate action should be taken and then reported to the doctor. The head of the bed should be lowered. • Do not leave unconscious patient alone. • Keep patient flat in bed with the head to the side (no pillows) and avoid chilling. • Watch color of skin, lips and fingernails carefully. • If there is any bleeding carry out the necessary measures and report immediately. • The patient is having pain after he is awake. Analgesic may be given according to orders. • Limit visitors in the patient’ room. • Carry out post operative orders carefully. • Place patient in a comfortable position.
Post operative care of specific surgeries 01/04/2025 By SENTAYEHU 44 Brain surgery  Patient must lie on his back without pillows unless ordered.  Room should be dark and quit to prevent irritation to the brain. Breast surgery  Encourage deep breathing often because of danger of pneumonia.  Special arm exercise should be given. Abdominal surgery  Encourage deep breathing  Turn from side to side often.  Sit patient on edge of bed on the first day post operative and start walking on the second day unless contraindicated.  Intake and output should be recorded.  If gastric suction is present make sure it is working properly.  Frequent mouth care for patients who are to allow drinking.
… 01/04/2025 By SENTAYEHU 45 Eye surgery  Must lie very still because the incision and sutures can be damaged by pulling on the eye muscles. Both eyes may be covered.  Room may be quiet and dark. Spinal surgery  Must lie on abdomen of back with bed flat and supported by fracture board mattress.  Patient may be in a body cast. Care must be given to prevent bed scares where the cast rubs.
… 01/04/2025 By SENTAYEHU 46 Thyroidectomy  Place in high fowler position. This will make it easier to breath since the pressure of dressing and swelling may give chocking feeling. Client’s are usually discharge from the post anesthetic room when;  They are conscious and oriented.  They are able to maintain a clear airway and deep breath and cough freely.  Protective reflexes (e.g. gag, swallowing) are active.  They are able to move four extremities.  Urinary intake and output is adequate.  Vital sign has been stabled.  Level of consciousness and orientation to time place and person: Asses reaction to verbal stimuli and ability to move extremities.
01/04/2025 By SENTAYEHU … 47 Client’s are usually discharge from the post anesthetic room when;  They are conscious and oriented.  They are able to maintain a clear airway and deep breath and cough freely.  Protective reflexes (e.g. gag, swallowing) are active.  They are able to move four extremities.  Urinary intake and output is adequate.  Vital sign has been stabled.  Level of consciousness and orientation to time place and person: Asses reaction to verbal stimuli and ability to move extremities.
01/04/2025 By SENTAYEHU 48  When caring for post-surgical patient, think of the “4 W’s” 1. Wind: prevent respiratory complications 2. Wound: prevent infection 3. Water: monitor I & O 4. Walk: prevent thrombophlebitis
Yakenyelay! አመሰግናለሁ:: 01/04/2025 49 By SENTAYEHU

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ppt for nurses chapter 9 perioperative care.pptx

  • 1.
  • 2.
    01/04/2025 By SENTAYEHU 2 Surgery  isa means of treating injury and disease.  It encompasses three phases preoperative, Intraoperative and postoperative.  All three phases are referred to a Perioperative nursing. Surgery may be performed  for diagnostic (e.g. excision of a tumor or inflamed appendix) or reparative (e.g. multiple wound repair). It may be reconstructive or cosmetic (e.g. mammoplasty or face lift) or  palliative (e.g. to relieve pain or correct a problem for instance a gastrostomy tube may be inserted to compensate for the inability to swallow food).
  • 3.
    01/04/2025 By SENTAYEHU 3 Degree ofurgency It can be classified as elective or emergency. 1. Elective surgery: may be planned weeks to months ahead and based on the client’s choice.  It is performed to satisfy the desire of the client but not needed to preserve the client’s life, body part or body function. E.g. cosmetic surgery, 2. Emergency surgery: is performed to preserve the client’s life, body part or body function. E.g. to control internal hemorrhage
  • 4.
    01/04/2025 By SENTAYEHU Cont’d… 4 Degree ofrisk:  It can be classified as major surgery or minor according to the degree of risk to the client. 1. Major surgery: it involves a high degree of risk for a variety of reason.  It may be complicated or prolonged large loss of blood may occur vital sign may be involved. E.g. organ transplant, open heart surgery 2. Minor surgery: It involves little risk produces few complications. E.g. breast biopsy
  • 5.
    01/04/2025 By SENTAYEHU 5 PERI-OPERATIVE CARE •is a period of time that constitutes the surgical experience including:  preoperative,  intra-operative and  post operative phases. 01/04/2025 5 By DelelegnT.
  • 6.
    Pre-operative care 01/04/2025 By SENTAYEHU 6 is a care given for a patient from the time the decision is made for surgical intervention to the transfer of the patient to the operating room Purpose  To prepare the patient emotionally, mentally for surgery  To prevent complication before surgery unless it is an emergency operation  To promote patient and family involvement in care
  • 7.
    Informed Consent 01/04/2025 By SENTAYEHU 7 Prior to any surgical procedures, client must sign a surgical consent form. This requirement protects clients from having any surgical procedures that do not want or do not know about. It is the part of a physician legal responsibility which involves providing the client until all the information needed to make the decision undergo surgery. Informed consent is necessary in the following circumstances. Invasive procedure such as a surgical incision a biopsy a cystoscopy or Paracentesis. Procedures requiring sedation or anesthesia. A non surgical procedure
  • 8.
    General checkup 01/04/2025 By SENTAYEHU 8 Assessinggeneral risks The degree of risk involved in surgical procedure is affected by the clients  Age many young and elderly clients are greater surgical risk than children and adults.  Nutritional status: two nutritional problems that can increase surgical risks are obesity and malnutrition due to protein, iron, and vitamin deficiencies. o Obese patient have overtaxed hearts and elevated blood pressure and incision in overly fatty tissues are difficulties to suture and prone to infection. o Protein and vitamins are needed for wound healing vitamin K is essential for blood clotting.
  • 9.
    … 01/04/2025 By SENTAYEHU 9  Fluidand electrolyte status  Medication: - the regular use of certain medication can increase surgical risk.  E.g. anticoagulant increase blood coagulation time, Tranquilizers may cause hypotension and thus contribute to shock  Health problem: such as angina pectoris, sever hypertension, myocardial infarction etc.  Blood coagulation disorder: that may lead to sever bleeding, hemorrhage.  Upper respiratory tract infection: they may predispose the client to postoperative lung infection.  Uncontrolled neurological disease such as epilepsy  Diabetes mellitus: which predispose the client to wound infection and delayed healing.  Screening test: The physician orders preoperative radio logic and laboratory tests and examination.
  • 10.
    01/04/2025 By SENTAYEHU 10 Equipment: 1. Bloodpressure apparatus 2. Stethoscope 3. Enema equipments and solution as needed 4. Catheterization equipments a. Flashlight b. Preoperative checklist c. Container for dentures, glasses
  • 11.
    Cont’d… 01/04/2025 By SENTAYEHU 11 d. Appropriatestorage for valuables and clothes e. Information packets regarding surgery f. Informed consent forms g. Intravenous fluids, IV set, syringe and needles, and equipment as needed h. Preoperative medication i. Transfer cart
  • 12.
    Procedures of pre-operativecare 01/04/2025 By SENTAYEHU 12 1. Explain the procedure 2. Check whether the client has any questions regarding the surgery and understands the procedure. 3. Wash hands 4. Verify admission orders regarding type of surgery, any risks (including recent changes in vital signs), and client preparation 5. Verify the client by checking name tag and asking name 6. Make the patient NPO for six to eight hours 7. Complete the preoperative checklist, including history, physical assessment, and check of valuables.
  • 13.
    Cont’d… 01/04/2025 By SENTAYEHU 13 8. Performneurological assessment, including checks for orientation, eye coordination, handgrips, knee bends, and plantar and dorsi-flexion of the feet 9. Perform vascular assessment including checks of pulse, blood pressure, and apical pulse rhythm, peripheral pulses, and temperature. Compare with previous information.  Clients over 50 years may require baseline electrocardiogram
  • 14.
    Cont’d… 01/04/2025 By SENTAYEHU 14 10. Auscultatethe lungs bilaterally front and back. If any wheezes, rhonchi, coughs, upper respiratory infections, or increased temperature, notify physician or qualified practitioner 11. Assess the gastrointestinal system (time of last meal, food allergies, bowel sounds, last bowel movement, time of last fluids). 12. Assess the genital/urinary system (last menstrual period, last void, state of pregnancy, estrogen replacement therapy).
  • 15.
    … 01/04/2025 By SENTAYEHU 15 13. Assessskin and muscle tone for any skin breakdown, redness, bruises, decreased skin integrity 14. Ascertain any allergies or adverse reactions during previous surgeries or use of anesthesia. 15. Obtain medication history, including the time and date of the last dose of medication 16. Ascertain any history of drugs/alcohol use and when they were last used. 17. Check weight.
  • 16.
    Cont… 01/04/2025 By SENTAYEHU 16 18. Checkif family is available and who is present 19. Ascertain if client has signed the surgical consent. 20. Remove all valuables with the exception of wedding rings if requested. Tape rings in place. Check and document whether valuables are placed in a locked area, safe storage area, or given to family. 21. Check if eyeglasses and dentures are removed; place in a labeled container
  • 17.
    Cont’d… 01/04/2025 By SENTAYEHU 17 22. Maintainelimination as needed (catheterization, enema) 23. Administer intravenous fluids according to orders 24. Administer medications according to orders. 25. Ascertain that preoperative checklist is complete. 26. Transport the client to appropriate area. 27. Inform family members where surgical waiting area is and establish a way to contact them when surgery is completed
  • 18.
    Preoperative teaching 01/04/2025 By SENTAYEHU 18 It includes teaching moving, leg exercise, deep breathing exercise and coughing Purpose Moving:  To maintain blood circulation  To stimulate respiratory function  To decrease stasis of gas in the intestine  To facilitate ambulation Leg exercise: To stimulate blood circulation there by preventing thrombopheleblitis and thrombus formation
  • 19.
  • 20.
    … 01/04/2025 By SENTAYEHU 20  Deepbreathing and coughing  To facilitate lung aeration thereby preventing atelectasis and pneumonia.  To promote blood circulation to and from the lungs there by preventing pulmonary embolism Procedure a) assist the client to fowler’s position(sitting) b) Have a client place hands palms down with middle finger touching along lower border of rib cage. c) Ask client to inhale slowly through the nose feeling middle fingers separate hold breath for 2to3 seconds. d) Have client exhale slowly through mouth repeat three to five times.
  • 21.
  • 22.
    Intra-operative care 01/04/2025 By SENTAYEHU 22 Definition: Intra-operative care is a care given for a patient from when the patient is transferred to operation room table to when the patient is admitted to the recovery room or post anesthesia care unit.
  • 23.
    01/04/2025 By SENTAYEHU 23 Purpose ofIntra-operative care • To prevent risk of infection • To reduce risk of injury related to Positioning chemical hazards foreign objects left in the body
  • 24.
    … 01/04/2025 By SENTAYEHU 24 There area lot of activities it includes:  Assessing the client’s physiologic and psycho logic status.  Reviewing the results of the diagnostic tests and lab studies.  Positioning the client for surgery performing the surgical preparation.  Assisting in preparing the sterile field.  Monitoring and maintain a safe, aseptic environment.  Managing catheters, tubes, drains and specimen.  Performing sponge sharp and instrument count.  Administering medication and solution to the sterile field.
  • 25.
    … 01/04/2025 By SENTAYEHU 25  Nursesassist surgeon in the operating room. The two basic categories of assistant are the sterile assistant and the circulating assistant.  The sterile assistant (scrub nurse) is scrubbed. Gowned and gloved he/she functions within the sterile field.  Duties include handling instruments to the surgeon, threading needles, cutting sutures assisting with retraction and suction and handling specimen.  The circulating nurse works outside the sterile field.  Duties include opening sterile packs delivering supplies and instruments to the sterile team delivering medication to sterile nurse labeling specimens and keeping records during the surgical procedure.
  • 26.
    01/04/2025 By SENTAYEHU 26 Equipment  Gloves(clean for shaving; sterile for cleaning surgical site)  Razor and sharp blades  Sterile gauze (to clean the razor)  Warm water  Antibacterial cleansing agent  Sterile cotton swabs  Sterile cotton sponges  Transfer forceps in antiseptic solution  Solution for surgical site cleaning, such as 70% alcohol Solution basins
  • 27.
    01/04/2025 By SENTAYEHU 27 Procedures 1. Reviewchart for surgery to be performed and determine the exact area to be prepared. 2. Wash hands. 3. Assess client’s level of consciousness and mobility 4. Explain the procedure to client. 5. Be sure that hairpins, jewelry, nail polish, contact lenses, prostheses, and dentures were re-moved during the preoperative preparation. 6. Assist client with transfer from wheelchair or bed to the surgical table. 7. Position the client for optimal access to the surgical site according to institutional protocol 8 .Cover with blanket
  • 28.
    Cont’d… 01/04/2025 By SENTAYEHU 28 9. Coverhair if required 10. Assemble equipment needed 11. Remove ring(s) and watch. Wash hands and apply clean gloves. 12. The surgical prep sites follow, depending on the type of surgery to be performed.  Head and neck: The site extends from above the eyebrows and includes the ears and both anterior and posterior areas of the neck. The face and eyebrows are not shaved.
  • 29.
    Cont… 01/04/2025 By SENTAYEHU 29  Lateralneck: Clean the external auditory canal with a cotton swab.  Anteriorly, prepare the side of the face, from above the ear to the upper thorax to just below the clavicle.  Posteriorly, prepare from the neck to the spine including the area above the scapula.  Chest surgery: The site extends from the neck to the bottom of the rib cage and to the lateral midline. The shoulder and arm of the operative side should be included.  Abdominal surgery: The preparation site extends from the axilla to the pubis extending bilaterally to the lateral midline. All visible pubic hair should be shaved.
  • 30.
    01/04/2025 By SENTAYEHU 30  Perinealsurgery: Shave all pubic hair and the inner thighs to the midthigh.  The area starts above the pubic bone anteriorly and extends beyond the anus posteriorly. Cervical spine surgery: Posteriorly from the top of the ears to the waist.  The area extends on each side to the midaxillary line. Lumbar spine surgery :Posteriorly from the axilla down to the midgluteal level of the buttocks. The area extends on each side to the midaxillary line
  • 31.
    01/04/2025 By SENTAYEHU 31  Rectalsurgery: Shave the buttocks from the iliac crest down to the upper third of the thighs, including the anal region. The area extends to the midline on each side.  Flank surgery: Extends anteriorly from the axilla, down to the upper thigh, including the external genital area.  Posteriorly the area extends from the midscapular to the midgluteal regions
  • 32.
    01/04/2025 By SENTAYEHU 32  Handand forearm surgery: The area includes the full circumference of the affected arm, from the axilla to the fingertips. Lower extremity surgery: The area includes the entire leg, toes, and foot of the affected leg from the umbilicus anteriorly and the top of the buttocks posteriorly. Lower leg surgery: The area to be prepared includes the circumference of the entire region from midthigh to the distal toes of the affected leg.
  • 33.
    Cont…procedure 01/04/2025 By SENTAYEHU 33 13. Arrangefor adequate light on the area to be prepared. 14. Using warm water, hold the skin taut and hold the razor at a 45° angle. Shave the area carefully by stroking in the direction of hair growth. Rinse the razor carefully to remove accumulated hair from the blade. 15. Dry the client’s skin with a sterile towel.
  • 34.
    Cont’d… 01/04/2025 By SENTAYEHU 34 16. Clearthe shaving supplies from the preparation area. 17. Apply sterile gloves and gown. 18. Scrub the surgical site with an antibacterial cleaner. Using a rotary movement to clean the skin, begin in the center and gradually enlarge the area with each rotation.
  • 35.
    ….cont 01/04/2025 By SENTAYEHU 35 19. Continuethis process for three to ten minutes as prescribed by institutional policy. 20. Clean any hidden areas in the surgical site (the ear canals, under the fingernails, the umbilicus) using cotton swabs. 21. Rinse the area with sterile water. Wait for the site to dry or pat dry with a sterile towel. 22. Cover the area with sterile drapes leaving the surgical site exposed  C:UserstoshibaDesktop Hand_washing,scrubing_gowning_gloving Surgical Hand Scrub Learning Module.mp4  C:UserstoshibaDesktop Hand_washing,scrubing_gowning_gloving Gloving,Gowning,and Surgical Scrub.mp4
  • 36.
    Postoperative Care 01/04/2025 By SENTAYEHU 36 Definition: Postoperative care is a care given for a patient which begins with the admission of the patient to the post anesthesia care unit and ends after follow up evaluation in the clinical setting. Purpose  To prevent any complication from anesthesia  To detect sign of post operative complications  To rehabilitate the patient  To re-establish physiological equilibrium  To alleviate pain
  • 37.
    01/04/2025 By SENTAYEHU 37 Equipments 1. Vitalsign equipments  Stethoscope  Sphygmomanometer  Thermometer 2. Watch, Anesthetic bed 3. Oximeter 4. Blankets 5. Cardiac monitoring equipment 6. Sterile dressings as needed 7. Client’s chart with postoperative orders 8. Incentive spirometer (may be optional) 9. Supplemental oxygen, if needed 10. Sequential stockings and/or antiembolic stockings (as ordered) 11. Gloves
  • 38.
    01/04/2025 By SENTAYEHU 38 Procedures 1. Washhands and apply gloves. 2. Check the client’s temperature, pulse, respiratory rate, and blood pressure upon the client’s arrival in the unit. 3. Identify client via armband and verify the client’s identity with the chart. 4. Inform the client that she/he is out of the operating room and in the recovery room.
  • 39.
    Cont’d… 01/04/2025 By SENTAYEHU 39 5. Ifbedside electrocardiogram monitoring is available, attach the leads to the client and run a baseline electrocardiogram strip. 6. Attach the oximeter to the client and monitor the client’s oxygen saturation
  • 40.
    01/04/2025 By SENTAYEHU Cont… 40 7. Checkintravenous (IV) site using gloves. Check IV solution(s), flow rate, and that the IV line is taped as necessary 8. Check surgical dressing and site, if visible. Assess dressings for amount and type of drainage. Reinforce the dressings as needed. 9. Complete a total head to toe assessment
  • 41.
    … 01/04/2025 By SENTAYEHU 41 10. Encouragethe client to deep breathe, cough, and use the incentive spirometer 11. Check and implement postoperative orders. 12. Inform the client’s family or significant other that the client is in the recovery room.
  • 42.
    01/04/2025 By SENTAYEHU 42 13. Turnthe client every hour, maintaining proper alignment. 14. Upon discharge by the postanesthesia care-giver, a full report of the postanesthesia phase and intraoperative course of events should be given to the nurse assuming care of the client. 15. Remove gloves and wash hands.
  • 43.
    General instructions 01/04/2025 By SENTAYEHU 43 •If patient shows any sign of shock immediate action should be taken and then reported to the doctor. The head of the bed should be lowered. • Do not leave unconscious patient alone. • Keep patient flat in bed with the head to the side (no pillows) and avoid chilling. • Watch color of skin, lips and fingernails carefully. • If there is any bleeding carry out the necessary measures and report immediately. • The patient is having pain after he is awake. Analgesic may be given according to orders. • Limit visitors in the patient’ room. • Carry out post operative orders carefully. • Place patient in a comfortable position.
  • 44.
    Post operative careof specific surgeries 01/04/2025 By SENTAYEHU 44 Brain surgery  Patient must lie on his back without pillows unless ordered.  Room should be dark and quit to prevent irritation to the brain. Breast surgery  Encourage deep breathing often because of danger of pneumonia.  Special arm exercise should be given. Abdominal surgery  Encourage deep breathing  Turn from side to side often.  Sit patient on edge of bed on the first day post operative and start walking on the second day unless contraindicated.  Intake and output should be recorded.  If gastric suction is present make sure it is working properly.  Frequent mouth care for patients who are to allow drinking.
  • 45.
    … 01/04/2025 By SENTAYEHU 45 Eye surgery Must lie very still because the incision and sutures can be damaged by pulling on the eye muscles. Both eyes may be covered.  Room may be quiet and dark. Spinal surgery  Must lie on abdomen of back with bed flat and supported by fracture board mattress.  Patient may be in a body cast. Care must be given to prevent bed scares where the cast rubs.
  • 46.
    … 01/04/2025 By SENTAYEHU 46 Thyroidectomy  Placein high fowler position. This will make it easier to breath since the pressure of dressing and swelling may give chocking feeling. Client’s are usually discharge from the post anesthetic room when;  They are conscious and oriented.  They are able to maintain a clear airway and deep breath and cough freely.  Protective reflexes (e.g. gag, swallowing) are active.  They are able to move four extremities.  Urinary intake and output is adequate.  Vital sign has been stabled.  Level of consciousness and orientation to time place and person: Asses reaction to verbal stimuli and ability to move extremities.
  • 47.
    01/04/2025 By SENTAYEHU … 47 Client’s areusually discharge from the post anesthetic room when;  They are conscious and oriented.  They are able to maintain a clear airway and deep breath and cough freely.  Protective reflexes (e.g. gag, swallowing) are active.  They are able to move four extremities.  Urinary intake and output is adequate.  Vital sign has been stabled.  Level of consciousness and orientation to time place and person: Asses reaction to verbal stimuli and ability to move extremities.
  • 48.
    01/04/2025 By SENTAYEHU 48  Whencaring for post-surgical patient, think of the “4 W’s” 1. Wind: prevent respiratory complications 2. Wound: prevent infection 3. Water: monitor I & O 4. Walk: prevent thrombophlebitis
  • 49.